ecqm.dataelement

Payer Patient Characteristic Payer

Description:

Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system

Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC

Inclusion Criteria: All codes in the code system

Exclusion Criteria: none

ResultValue constrained to codes in the Payer valueset (2.16.840.1.114222.4.11.3591)

QDM Datatype: PatientCharacteristicPayer

Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The first day of insurance coverage with the referenced payer stopTime – The last day of insurance coverage with the referenced payer

Used By:

• CMS102v7,
• CMS104v7,
• CMS105v7,
• CMS107v7,
• CMS108v7,
• CMS111v7,
• CMS113v7,
• CMS117v7,
• CMS122v7,
• CMS123v7,
• CMS124v7,
• CMS125v7,
• CMS127v7,
• CMS128v7,
• CMS129v8,
• CMS130v7,
• CMS131v7,
• CMS132v7,
• CMS133v7,
• CMS134v7,
• CMS135v7,
• CMS136v8,
• CMS137v7,
• CMS138v7,
• CMS139v7,
• CMS142v7,
• CMS143v7,
• CMS144v7,
• CMS145v7,
• CMS146v7,
• CMS147v8,
• CMS149v7,
• CMS153v7,
• CMS154v7,
• CMS155v7,
• CMS156v7,
• CMS157v7,
• CMS158v7,
• CMS159v7,
• CMS160v7,
• CMS161v7,
• CMS164v7,
• CMS165v7,
• CMS167v7,
• CMS169v7,
• CMS177v7,
• CMS190v7,
• CMS22v7,
• CMS249v1,
• CMS26v6,
• CMS2v8,
• CMS31v7,
• CMS32v8,
• CMS347v2,
• CMS349v1,
• CMS50v7,
• CMS52v7,
• CMS53v7,
• CMS55v7,
• CMS56v7,
• CMS645v2,
• CMS65v8,
• CMS66v7,
• CMS68v8,
• CMS69v7,
• CMS71v8,
• CMS72v7,
• CMS74v8,
• CMS75v7,
• CMS82v6,
• CMS90v8,
• CMS9v7

QDM Attributes

ResultValue.CodeableConcept

Defined in Observation

Value Set

Constrained in PayerPatientCharacteristicPayer

https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion (REQUIRED)

RelevantPeriod

Relevant Period addresses the time between the start of an action to the end of an action. Each datatype using relevant period defines specific definitions for the start and stop time for the action listed.